1669928974 NPI number — LEYSAN, LLC

Table of content: (NPI 1669928974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669928974 NPI number — LEYSAN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEYSAN, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEADOW HILLS ASSISTED LIVING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669928974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 W CIMARRON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOGALES
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85621-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-287-2388
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1935 W MEADOW HILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOGALES
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85621-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-415-1416
Provider Business Practice Location Address Fax Number:
520-415-1417
Provider Enumeration Date:
08/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
520-265-6616

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL9688H , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 032114 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 053987 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150410 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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